路亚枫 吕树铮 陈韵岱 宋现涛 张抒扬 霍勇

DOI：10.3760/cma.j.issn.1671-0282.2015.03.008

基金項目：北京市科委重大科技计划（D0906006040191）

作者单位：100176 北京，首都医科大学附属北京同仁医院心血管中心（路亚枫）;首都医科大学附属北京安贞医院心内科（吕树铮、宋现涛）;中国人民解放军总医院心内科（陈韵岱）;北京协和医院心内科（张抒扬）;北京大学第一医院心内科（霍勇）

通信作者：吕树铮，Email：shuzheng@medmail.com.cn

【摘要】目的 评价冠心病患者胎盘生长因子（PLGF） 、可溶性酪氨酸激酶受体-2水平（sTie-2）与冠状动脉临界病变的斑块影像形态学特征的相关性。方法 连续入选北京4家三级教学医院2007年4月至2009年9月期间经冠脉造影证实的具有临界病变（三支主要血管狭窄大于20%且小于70%，血管直径超过2.25 mm）的患者共719例，分为不稳定型心绞痛（UAP）组292例，稳定型心绞痛组（SAP）219例和冠状动脉粥样硬化（AS）组208例。对靶血管进行定量冠状动脉造影（QCA）分析，应用蛋白芯片方法测定2种细胞因子：血浆胎盘生长因子及血浆可溶性酪氨酸激酶受体-2含量的变化。分析三组患者两种血管因子水平的变化与冠脉临界病变的斑块影像形态学特征的相关性。结果 （1）UAP组血浆PLGF 80.33 ng/L水平显著高于SAP组54.29 ng/L和AS组45.16 ng/L（均P<0.05），UAP组血浆sTie-2水平1353.06 ng/L 显著高于AS组1308.28 ng/L（P=0.008）。（2）QCA分析显示SAP组病变最小管腔直径、直径狭窄率、最小管腔面积、面积狭窄率与UAP、AS组之间差异有统计学意义，UAP组斑块面积显著大于 AS组（P<0.05）。（3）冠脉病变形态学显示三组之间易损斑块比较差异有统计学意义（P<0.01）。（4）血管因子与斑块形态学相关性分析：PLGF与管腔最小面积存在正相关，r=0.493（P=0.009）。结论 PLGF、sTie-2提示斑块内新生血管，可作为冠脉斑块易损性的预测指标。

【关键词】冠心病;胎盘生长因子;可溶性酪氨酸激酶受体-2;定量冠脉造影

A study in the correlation between vascular factors and plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease

Lu Yafeng， Lü Shuzheng， Chen Yundai， Song Xiantao，Zhang Shuyang， Huo Yong. Cardio-Vascular Center， The Affiliated Tongren Hospital of Capital Medical University， Beijing 100176， China

Corresponding author：Lü Shuzheng，Email：shuzheng@medmail.com.cn

【Abstract】Objective To investigate the correlation between the levels of placenta growth factor （PLGF）， soluble angiopoietin receptor-2 （sTie-2） and critical coronary artery plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease （CHD）.Methods In three consecutive years from April 2007 to September 2009， a cohort of 719 patients with borderline coronary lesions with stenosis in three main vessels with lumen diameter reduction varied all the way from more than 20% to less than 70% and with greater than 2.25 mm of the inner diameter were selected in this study from 4 teaching hospitals of tertiary class A in Beijing. These patients fell into three categories： unstable angina pectoris （UAP， n=292）， stable angina pectoris （SAP， n=219） and coronary arteriosclerosis （AS， n=208）. The vessels involved were analyzed using quantitative coronary angiography （QCA）. Plasma levels of PLGF and sTie-2 were measured by using protein chip. The relationship between plasma levels of vascular factors， sTie-2，PLGF and coronary artery plaque imaging morphology among three groups were analyzed.Results （1） Plasma level of PLGF was 80.33 ng/L in the UAP group， which was significantly higher than 54.29 ng/L in the SAP group and 45.16 ng/L in AS group （both P<0.05）. Plasma level of sTie-2 was 1353.06 ng/L in the UAP group， which was significantly higher than 1308.28 ng/L in the AS group （P=0.008）. （2） There was significantly statistical differences in QCA between the SAP group and the UAP group as well as the AS group （both P<0.05） in terms of the minimal lumen diameter， diameter stenosis rate， minimal lumen cross-sectional area and cross-sectional area of stenosis. The plaque area in the UAP group was larger than that in the AS group （P=0.013）. （3） The relationship between vascular factors and plaque imaging morphology was analyzed. There was significantly statistical difference in the involved lesions among the three groups （P<0.01）. （4）There was a positive correlation between plasma level of PLGF and minimal lumen cross-sectional area （r=0.493，P=0.009）. Conclusions The plasma levels of PLGF and sTie-2 reflect the level of neo-vascularization in the plaque， and could be taken as predictive factors for potential pathogenesis of coronary plaque.

【Key words】Coronary heart disease;PLGF;sTie-2;Quantitative coronary angiography

急性冠脉综合征（acute coronary syndrome，ACS）的病理基础是易损斑块的进展和破裂导致血小板的聚集和继发血栓形成，而不取决于冠脉狭窄的严重程度[1]。易损斑块的病理学研究提示斑块破裂多发生于轻-中度冠脉狭窄的患者，故冠脉临界病变的研究具有重要意义。……